LEFT BASAL GANGLIA LACUNE.
This form of infarct involves small arterioles. In the acute phases of a lacunar infarct, the CT scan may be normal. As the infarct develops it becomes progressively lower in attenuation indicating its chronicity. Due to the dense concentration of neurons in the basal ganglia, a small lacunar infarct may have a dramatic clinical picture. The role of a CT scan in the initial phases of an infarct is essentially to rule out the presence of hemorrhage so that the patient can be anticoagulated. The presence of a very large hemispheric infarct may also preclude the possibility of anticoagulation. Such infarcts may sometimes be noted on the initial CT scan examinations.
VENTRICULO-SULCAL PROMINENCE OF AGE.
Otherwise known as atrophy. Progressive loss of neurons within the central nervous system with age results in prominence of the ventricles as well as the cisterns when compared with normal age individuals. This does not correspond to the degree of cognitive function. However, the finding of ventriculo-sulcal prominence which is out of proportion to that of the patient's age should raise the suspicion of pathologic processes such as demyelinating diseases, the vasculitidies or chronic cerebro-vascular disease.
The small arrow heads point to the sulcal prominence. The large arrows point to the prominent, frontal, temporal horns, the lateral ventricle as well as the prominent fourth ventricle in this order.
BILATERAL BASAL GANGLIA LACUNAR INFARCTS
The arrows point to the presence of ovoid areas of well defined low attenuation within the basal ganglia bilaterally. These represent old lacunar infarcts. Also note the ventriculo-sulcal prominence (atrophy).
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